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A Robot Named ‘da Vinci’ Puts USC at the Forefront of Surgery

Before using the robot, surgeon Vaughn Starnes had to enter between two of the patient’s ribs to reach the mitral valve, creating an opening for the surgical instruments he later manipulated using the da Vinci robot.

Vaughn Starnes, professor and chair of cardiothoracic surgery, and his team of cardiothoracic surgeons – assistant professors Daniel Schwartz and Ross Bremner – repaired the mitral valve of patient Lotte Henderson on April 27 at USC University Hospital using the da Vinci Surgical System.

“Robotic surgery is going to revolutionize cardiothoracic procedures,” Starnes said. “This is truly the next advance in heart surgery.”

The system allowed Starnes to operate on Henderson remotely by using controls on a computer console. The surgical instruments were inserted through small holes in Henderson’s side.

Traditional mitral valve surgery involves a long incision, and surgeons must split the breastbone to reach the heart. Even using advanced techniques, the incision can be four inches long. But through the small punctures and tiny instruments involved in minimally invasive robotic surgery, patients experience shorter incisions, less pain and trauma and a quicker recovery time.

The da Vinci Surgical System, a product of Intuitive Surgical (based in Mountain View, Calif.), teams the surgeon’s skills with computer-enhanced robotic technology. USC is one of several sites in the United States in a Food and Drug Administration-approved trial to evaluate the use of the da Vinci Surgical System to repair the heart’s mitral valve.

Surgeons repair the mitral valve to treat leakage of the valve, which helps pump blood through the heart. The valve separates the heart’s left atrium (upper chamber) from its left ventricle (lower chamber). A weakened valve can cause blood to back up into the lungs, causing the ventricle to pump more blood and producing symptoms of shortness of breath and tiredness.

During the procedure, Starnes sat at a console about eight feet away from the patient, while a three-armed, 1,000-pound robot was positioned beside her.

Starnes grasped and moved highly sensitive instruments at the console while viewing Henderson’s heart – greatly magnified – on a screen. The robot precisely matched Starnes’ natural hand and wrist movements, translating them to the tiny instruments placed inside the patient through small puncture incisions.

The procedure required three small incisions between the ribs, two for the insertion of interchangeable instruments and another for a thin, cylindrical video camera, called an endoscope. Starnes shaped and sutured tissue into place, shortening a cord (a sort of “heart string”) that supports the heart valve. He also sewed in a shoelace-like ring to brace the valve.

The robot operated silently but created quite a buzz in the hallway outside the operating room, where other surgeons, physicians and nurses crowded around a television screen to watch the procedure. Some peered through operating room windows to try to get a better look.

“Mitral valve repairs technically are among those requiring the most skill from a surgeon,” said Schwartz, who assisted in the procedure. “This is a procedure not many people across the country do, even without a robot.

“The robot is able to perfectly mimic the surgeon’s hand, all in a very small area. The robot can be so delicate you can carefully place sutures the size of a human hair,” he said.

Starnes noted that the robotic technology is a spin-off of defense technology. Intuitive Surgical developed the da Vinci system at the urging of the Pentagon, which sought a way for military surgeons to perform operations remotely, without being on the front lines or at sea.